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New consensus to enable early detection and treatment of sarcopenia

Loss of muscle and strength is a key part of the ageing process. When muscle loss and weakness become severe and established the condition is known as sarcopenia. Identification and measurement of this condition remains one of the major challenges of modern medicine.

A new consensus enabling the early detection and treatment of sarcopenia was published today in Age and Ageing, the scientific journal of the British Geriatrics Society.

The consensus was developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and is an update of the first EWGSOP guidelines published in 2010. The new guidance also aims to increase awareness of sarcopenia among healthcare professionals, and encourage more research in the field. The new consensus is endorsed by a number of international Societies including the European Geriatric Medicine Society, the European Society for Clinical Nutrition, The European Society for Clinical and Economic Aspects of Osteoporosis Osteoarthritis and Musculoskeletal Diseases, the International Osteoporosis Foundation and International Association of Gerontology and Geriatrics for the European Region.

Studies have shown that sarcopenia increases risk of falls and fractures, impairs ability to perform the activities of daily living, lowers quality of life, increases loss of independence, and raises mortality rates. In financial terms, sarcopenia is costly to healthcare systems. Among older adults who are hospitalised, those with sarcopenia on admission were more than five times more likely to have higher hospital costs.

There are a number of important changes to the guidance from 2010, including an easier way to screen for sarcopenia risk (SARC-F), a systematic way to make the sarcopenia diagnosis, and suggestions for practical tools and tests at each step. The new consensus also underscores the importance of low physical function as a red flag for severe sarcopenia.

The new consensus also highlights areas requiring further research. The underlying disease mechanisms of sarcopenia remain poorly understood and the syndrome may well encompass multiple subtypes, driven by different underlying risk factors or diseases. The new guidance attempts an important next step in classifying sarcopenia into primary and secondary forms, which should accelerate research endeavours in this area.

Professor Alfonso Cruz-Jentoft, Director of the Geriatric Department of the Hospital Universitario Ramón y Cajal in Madrid and lead contributor of the new guidelines, commented:

“There is no doubt that sarcopenia is now well established as an important area of research activity, both within geriatric medicine and increasingly in organ specialities such as cardiology, respiratory medicine, and oncology. Will this research activity translate into clinical activity focussed on sarcopenia, as the authors of the guideline would like to see? For this to happen, sarcopenia has to be routinely detected and addressed in clinical practice. Diagnosing sarcopenia will have to lead to treatment strategies that would otherwise not be triggered as part of current care. The treatments proven to work so far – resistance training and nutrition intervention – are not unique to sarcopenia, and are already indicated for the related syndrome of frailty. It may be that for sarcopenia to find a place in daily geriatric medicine practice – and in general medical care, we must wait for specific, effective treatments that merit spending time and effort on making the diagnosis of sarcopenia. As research progresses towards that goal, these new guidelines are an important and commendable next step on the road.”

These new guidelines are an update to the previously published Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People published in ‘Age and Ageing’ in 2010 which can be read here: https://academic.oup.com/ageing/article/39/4/412/8732